Healthcare Provider Details

I. General information

NPI: 1518331750
Provider Name (Legal Business Name): R. DENISE CLAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2015
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 BARBARA LOOP SE SUITE #107
RIO RANCHO NM
87124-1039
US

IV. Provider business mailing address

9200 SPAIN RD NE
ALBUQUERQUE NM
87111-2212
US

V. Phone/Fax

Practice location:
  • Phone: 505-306-4060
  • Fax:
Mailing address:
  • Phone: 505-306-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0177271
License Number StateNM

VIII. Authorized Official

Name: MRS. ROCHELL DENISE CLAY
Title or Position: PROFESSIONAL CLINICAL COUNSELOR
Credential: MA,LPCC, NCC
Phone: 505-306-4060